title: Mortality, incidence of cardiovascular diseases, and educational level among the diabetic and non-diabetic populations in two large Italian cities.
abstract: OBJECTIVE
  We investigated if diabetes modifies the effect of the association of education with mortality and incidence of cardiovascular diseases.
  
  
  METHODS
  We identified 44,889 diabetics using multiple data sources. They were followed up from January 2002 up to December 2005, and their mortality, incidence of myocardial infarction and stroke, by educational level were analysed, and compared with those of the local non-diabetic population.
  
  
  RESULTS
  The all-cause Standardized Mortality Ratios among diabetics, compared with non-diabetics, were 170 for men and 175 for women. Standardized Incidence Ratios were 199 for myocardial infarction, and 183 for stroke in men and, respectively, 281, and 179 in women. Among non-diabetics there was a clear inverse relation with educational level for all outcomes, whereas among diabetics no significant social difference in incidence was found; slight social differences in mortality were present among men, but not among women. The effect of diabetes on social differences was enhanced in the youngest population.
  
  
  CONCLUSIONS
  Diabetes increases the risk of death and the incidence of vascular diseases, but reduces their inverse association with education. This is likely related to the high accessibility and good quality of health care provided by the local networks of diabetic centres and primary care.
authors.affiliation: Epidemiology Unit, ASL TO3, Via Sabaudia 164, Regione Piemonte, Grugliasco, TO, Italy. roberto.gnavi@epi.piemonte.it
authors.forename: R
authors.initials: R
authors.lastname: Gnavi
authors.forename: C
authors.initials: C
authors.lastname: Canova
authors.forename: R
authors.initials: R
authors.lastname: Picariello
authors.forename: R
authors.initials: R
authors.lastname: Tessari
authors.forename: C
authors.initials: C
authors.lastname: Giorda
authors.forename: L
authors.initials: L
authors.lastname: Simonato
authors.forename: G
authors.initials: G
authors.lastname: Costa
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality*; D002947:Cities / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology*; D004522:Educational Status; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality; D055815:Young Adult